Behçet's Syndrome with Colonic Involvement and Arterial Thrombosis

[Multiple arterial thrombosis in Behçet's disease]

Behcet's disease (BD) is a multisystemic vasculitis. Its etiopathogeny remains unknown. Vascular involvement in BD is frequent and venous thrombosis is the most common manifestation (30% of cases). Arterial involvement is rare (2.7 to 7%). The latter is often severe and considered as a life threatening complication. Pathogenesis of thrombosis occurring in BD remains unclear. We report a 45-year-old man, from south of Tunisia, who presented a BD with a bifocal arterial involvement: right internal carotid thrombosis and bilateral proximal thrombosis of the two pulmonary arteries. Therapeutic strategies to address this multiple arterial involvement and the pathogenesis of thrombosis raise many questions.

Behçet's syndrome with gastro-intestinal tract involvement mimicking carcinoma of the caecum--a case report

A 43-year-old patient with a 2-year history of orogenital ulceration and hypochromic anaemia developed rapid loss of weight over a period of a few months and presented with a mass in the right iliac fossa, suggestive, clinically and radiologically, of a carcinoma of the caecum. The mass was removed by standard right hemicolectomy. Examination of the resected specimen revealed a large, irregular, ulcerated area of the caecum measuring 7 cm in diameter extending through all the layers of the intestinal wall. Histology showed a non-specific inflammatory infiltrate. One large artery in the pericolic tissue was occluded by organizing thrombus. Five years after the operation, he developed epileptiform seizures. CT scan showed a small infarct in the left insular area of the brain. Six months later he was admitted to another hospital with profuse diarrhoea and died within 24 h from cardiac arrest.

[Arterial manifestations of Behçet's disease. 12 cases]

Out of 196 patients with Behçet's disease, 12 (10 men and 2 women, mean age 34 +/- 7 years) had non-coronary arterial lesions. Behçet's disease was complete in 4 patients. The arterial lesions had appeared 8.6 +/- 8 years on average (20 years at most) after the first sign of the disease. Three patients showed evidence of stenosis or occlusion involving one or several arteries. Eight patients had both stenotic and aneurysmal lesions. One patient had an arteriovenous fistula. Another developed a false aneurysm at the site of introduction of a femoral catheter. Yet another patient developed an anastomotic aneurysm one year after implantation of an abdominal aortic graft. In 2 cases histology showed fragmentation of the media associated with vasculitis of the vasa vasorum. Two patients with pulmonary aneurysm died of massive haemoptysis. In 2 patients combined corticosteroid and cyclophosphamide therapy failed to prevent the development of aneurysmal lesions. Phlebitis was associated with arterial involvement in 7 patients. Comparison between patients with or without arterial lesions showed no significant difference in time of onset of Behçet's disease, sex, main clinical features and presence of HLA B5. Aneurysmal lesions respond poorly to medical treatment, and surgery is mandatory. Since recurrence at the site of anastomosis is possible, prolonged monitoring is required.